Abstract：
BACKGROUND: Peroral endoscopic myotomy (POEM) is an emerging effective treatment for achalasia. However, a significant proportion of patients do not respond well to the treatment. After over a decade of clinical practice, potential risk factors associated with POEM failure have been identified. This meta-analysis aimed to summarize the evidence of risk factors for POEM failure.
METHODS: A systematic literature search was conducted on PubMed, Embase, Web of Science, and Cochrane Library from inception to June 10th, 2022. We included English studies that reported POEM outcomes in achalasia patients and identified risk factors for POEM failure. Relevant information was extracted and analyzed using fixed- or randomized-effect models to pool the effect size.
RESULTS: A total of 27 studies comprising 9371 patients with achalasia were included in this review. The pooled failure rate was 8% (90% CI 7%-10%). We identified sigmoid esophagus (OR 1.90, 95% CI 1.45-2.47), type I achalasia (OR 1.30, 95% CI 1.04-1.63), and type III achalasia (OR 1.26, 95% CI 0.89-1.78) were associated with a worse clinical response. Conversely, type II achalasia was associated with a better response (OR 0.59, 95% CI 0.47-0.75). Prior treatment with Heller myotomy (OR 5.75, 95% CI 3.97-8.34) and prior balloon dilation (OR 1.18, 95% CI 1.07-1.29) were also associated with a higher risk of clinical failure.
CONCLUSIONS: Our meta-analysis results demonstrated that sigmoid esophagus, manometric achalasia subtype, and prior treatment were associated with POEM failure. This information could be used to guide treatment decisions and improve the success rate of POEM in achalasia patients.
METHODS: A systematic literature search was conducted on PubMed, Embase, Web of Science, and Cochrane Library from inception to June 10th, 2022. We included English studies that reported POEM outcomes in achalasia patients and identified risk factors for POEM failure. Relevant information was extracted and analyzed using fixed- or randomized-effect models to pool the effect size.
RESULTS: A total of 27 studies comprising 9371 patients with achalasia were included in this review. The pooled failure rate was 8% (90% CI 7%-10%). We identified sigmoid esophagus (OR 1.90, 95% CI 1.45-2.47), type I achalasia (OR 1.30, 95% CI 1.04-1.63), and type III achalasia (OR 1.26, 95% CI 0.89-1.78) were associated with a worse clinical response. Conversely, type II achalasia was associated with a better response (OR 0.59, 95% CI 0.47-0.75). Prior treatment with Heller myotomy (OR 5.75, 95% CI 3.97-8.34) and prior balloon dilation (OR 1.18, 95% CI 1.07-1.29) were also associated with a higher risk of clinical failure.
CONCLUSIONS: Our meta-analysis results demonstrated that sigmoid esophagus, manometric achalasia subtype, and prior treatment were associated with POEM failure. This information could be used to guide treatment decisions and improve the success rate of POEM in achalasia patients.
摘要：
背景：经口内镜下肌切开术（POEM）是一种新兴的有效治疗贲门失弛缓症的方法。然而,相当比例的患者对治疗反应不佳.经过十多年的临床实践，已确定与POEM故障相关的潜在风险因素。本荟萃分析旨在总结POEM失败危险因素的证据。
方法：在PubMed上进行了系统的文献检索，Embase,WebofScience,和Cochrane图书馆从成立到6月10日，2022年。我们纳入了英国研究，这些研究报告了门失弛缓症患者的POEM结局，并确定了POEM失败的危险因素。使用固定或随机效应模型提取和分析相关信息以汇集效应大小。
结果：本综述共纳入27项研究，包括9371例贲门失弛缓症患者。合并失败率为8%(90%CI7%-10%)。我们确定了乙状结肠食管（OR1.90，95％CI1.45-2.47），I型贲门失弛缓症（OR1.30，95%CI1.04-1.63），和III型贲门失弛缓症(OR1.26,95%CI0.89-1.78)与较差的临床反应相关。相反，II型贲门失弛缓症与较好的反应相关(OR0.59,95%CI0.47-0.75).先前使用Heller肌切开术（OR5.75，95％CI3.97-8.34）和先前的球囊扩张（OR1.18，95％CI1.07-1.29）的治疗也与更高的临床失败风险相关。
结论：我们的荟萃分析结果表明，乙状结肠食管，测压弛缓症亚型，和以前的治疗与POEM失败有关。这些信息可用于指导治疗决策并提高POEM在门失弛缓症患者中的成功率。
方法：在PubMed上进行了系统的文献检索，Embase,WebofScience,和Cochrane图书馆从成立到6月10日，2022年。我们纳入了英国研究，这些研究报告了门失弛缓症患者的POEM结局，并确定了POEM失败的危险因素。使用固定或随机效应模型提取和分析相关信息以汇集效应大小。
结果：本综述共纳入27项研究，包括9371例贲门失弛缓症患者。合并失败率为8%(90%CI7%-10%)。我们确定了乙状结肠食管（OR1.90，95％CI1.45-2.47），I型贲门失弛缓症（OR1.30，95%CI1.04-1.63），和III型贲门失弛缓症(OR1.26,95%CI0.89-1.78)与较差的临床反应相关。相反，II型贲门失弛缓症与较好的反应相关(OR0.59,95%CI0.47-0.75).先前使用Heller肌切开术（OR5.75，95％CI3.97-8.34）和先前的球囊扩张（OR1.18，95％CI1.07-1.29）的治疗也与更高的临床失败风险相关。
结论：我们的荟萃分析结果表明，乙状结肠食管，测压弛缓症亚型，和以前的治疗与POEM失败有关。这些信息可用于指导治疗决策并提高POEM在门失弛缓症患者中的成功率。
